Prenatal care

Prenatal care should preferably be preceded by conscious family planning, which has many advantages compared to accidental conception. Some of the more important advantages are listed here:

  • The family and individual medical history can help prevent possible hereditary disorders in the offspring.
  • Gynecological screening can prevent several conditions and diseases that may have an adverse effect on the pregnancy.
  • Special tests and examinations are applied to check fertility. They help to reveal the sadly growing number of cases where either or both members of a couple wanting a baby need treatment. Currently their rate is 20%.
  • If the woman starts taking multivitamins containing folic acid at least a month before conception a large number of developmental abnormalities can be prevented.
  • Early pregnancy can be protected from various external harms.
  • Ectopial pregnancy can be detected by an ultrasonic scan done just a few days after the woman skips her menstrual period.

Appropriate prenatal care is provided in the context of regular visits to the surgery of the obstetrician and obstetric nurse, where different tests and examinations are carried out depending on the gestational age:

4-6 weeks

Early ultrasonic scan: the purpose of this first ultrasound scan is to check the position of the embryo and to eliminate the possibility of ectopial pregnancy. At this stage multiple pregnancy, where the embryos develop in separate sacs can be recognized.

Lab tests: full blood panel, urine test, blood sugar, Lues serology, cholesterol and triglyceride. Testing Rh-negative mothers for antibodies.

9-10 weeks

Ultrasound scan: the obstetrician scans the size and development of the embryo and checks its heart function. At this stage the embryo is 2.3-4 cm in size.

At this time multiple pregnancy in one sac can be recognized.

12-14 weeks

The first genetic screening takes place at 12-14 weeks (ideally at 12 weeks). Now the embryo’s CRL (crown-rump length) is between 45 and 84 mm. A Combined test is recommended, which is one of the most efficient methods of screening for chromosomal disorders. It consists of a detailed ultrasonic scan, and maternal blood tests.

The full test takes about 1-1.5 hours and the mother will be given the test results at the end-of-test consultation.

16-18 weeks

This is the recommended time for AFP and HbsAg screening. The Serum quadruple test (AFP, uE3, Free ß-hCG, Inhibin-A) can be carried out on women who for some reason missed the Combined test.

The purpose of the AFP test is to reveal possible abnormalities, primarily open neural tube (spina bifida) as early as possible.

The AFP test alone is not sufficient for Down’s syndrome risk assessment!

18-21 weeks

This is the time of the second ultrasonic screening for genetic abnormalities (two weeks after the AFP test).

In possession of the AFP test result, the sonographer checks the baby from head to toe. In most cases the sonographer also measures the BPD (biparietal diameter or the diameter of the head), HC (head circumference), AD (abdominal diameter), AC (abdominal circumference), FL (femur length) in order to determine the proportions and development of the fetus.

The cerebral structure and cerebral ventricles, the palate, the lips, the lenses are examined. The organs in the chest cavity are also examined; special attention is paid to the chambers, valves and outflow tracks of the heart. The abdominal cavity below the diaphragm is checked including repletion of the stomach, the structure of the kidneys, translucency of the intestines (i.e. their ability to reflect ultrasound), and repletion of the bladder. If filled with fluid the stomach and the bladder appear as dark areas in the sonogram.

At this time the sex of the fetus can be verified with certainty.

For mothers whose history (prematurity) or complaints (lower abdominal cramps) justifies it, cervical length and dilation should also be recorded from 21 weeks so that pending prematurity can be recognized in time.

26 weeks

Lab tests, glucose tolerance test, screening for antibodies.

If an hour after ingestion of 2 dl milk and a bread roll the blood sugar level is above 7 a glucose tolerance test is carried out and if necessary, a low carbohydrate diet is recommended.

If this does not solve the problem a diabetic consultant is involved, who will put the mother on insulin. In such cases we recommend the baby should be delivered at one of the specialist OB-GYN clinics.

30 weeks

Fetal growth, placenta function and the amount of the amniotic fluid are monitored.

This is the recommended time for 4D ultrasonic imaging.

33 weeks

Lab tests, blood pressure and weight check. Recommended time for 4D ultrasonic imaging.

36 weeks

Vaginal examination to check cervical length and dilation. CTG is done weekly to check the baby’s heart rate along with any contractions of the uterus and placental function. We want to make sure the placenta supplied enough oxygen and nutrients to the fetus.

A vaginal smear culture is taken to eliminate streptococcus-B infection as this bacterium causes most of the severe perinatal infections.

Blood pressure and urine control.

37 weeks

CTG; OB examination to check cervical length and dilation. Blood pressure and urine control. Discussion of the result of the vaginal smear culture.

38 weeks

Same as at 37 weeks.

39 weeks

Ultrasonic estimation of the fetal weight, checking monitoring function, ultrasound scan of the placenta, checking the amount of the amniotic fluid and the umbilical artery by means of flow mapping.

Other tests are the same as in earlier weeks. Depending on the cervical state steps towards programmed birthing may be recommended.

40 weeks

Same as 38 weeks tests, possibly supplemented by amnioscopy (this procedure is performed to determine the colour of the amniotic fluid by means of a thin metal tube introduced in the cervix). After 40 weeks CTG scans are conducted every other day and flow mapping is recommended every 3 of 4 days.

If the baby is 10 days overdue after 40 weeks labour will be induced.